JANUARY 2016 CASE STUDY

HPI

You and your partner are working on an ALS rig in an urban setting. You’re dispatched to a breathing problem at a private residence for 35yom complaining of shortness of breath and “stabbing” chest pain on the right side that is not exacerbated by palpation or deep inspiration. The patient states that he had an acute onset of chest pain approximately two hours ago while he was at rest, and it progressed into severe dyspnea. The patient is ambulatory on your arrival, appears markedly anxious, and is mildly dyspneic.

MEDICAL HISTORY

COPD

DVTs/PE

Cardiac Arrest due to PE

Four cardiac stents

Diabetes

MEDICATIONS

Lantus

Novolog

Lisinopril

Metoprolol

Clopidogrel

Albuterol

Symbicort

ALLERGIES

Penicillin

Vicodin

Morphine

ASSESSMENT

Strong, regular, and rapid radial pulses

Skin is warm, pale, and dry

Respirations appear mildly dyspneic

L/S reveal mild expiratory wheeze in the R upper lobe, and clear but diminished in the L side

Respirations of 28; 4-5 word sentences

Pupils PERRL

No obvious trauma noted

Patient is a GCS

VITAL SIGNS AND DIAGNOSTICS

BP: 180/132

HR: 124

RR: 28/mildly labored

SpO2: 98% R/A and 99% on NRB @15lpm

Blood glucose: 285mg/dl

EtCO2: 39

Dyspnea does not improve with NRB

Are you suspecting more of a cardiac or respiratory presentation? Combination of both?